Systematic Withdrawal/ Installment Payment Option Request · Systematic Withdrawal/ Installment...

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Section A - Plan Information (required) Plan Name Group No. Section B - Participant Information (required) * Legal Address Daytime Phone Number Zip Code State City Date of Birth Participant Name SSN *We will change your account information to reflect the Legal Address above and all future mailings will be sent to this address unless changed by you or your Plan Administrator as described under "Stale Address" in the Important Information Section. SWO/RMD IPO 375-10/243-18 Rev 1.15 Page 1 of 6 ipo/ipoqual.pdf Use this form if you want to: • request a series of payments from your vested account. Do not use this form if: • you want to modify or terminate an existing SWO/IPO program. Use the Systematic Withdrawal/ Installment Payment Option Change Form. You may use the Change Form to stop the program or make changes to the following: payment amount; withholding; EFT; payment date; payment frequency; specific investment choices or contribution sources. • you want to request a hardship withdrawal under a 403(b) or 401(k) plan (if your Plan allows, use the Hardship Withdrawal Request Form) or Unforeseeable Emergency Withdrawal under a 457(b) plan (if your Plan allows, use the Unforeseeable Emergency Withdrawal Request Form.) • you are 70½ or older and your accumulated installment payments for the year are not sufficient to fulfill your current year Required Minimum Distribution (RMD) (use the Required Minimum Distribution Request Form to request the additional amount.) you are a requesting a distribution following the death of a Plan Participant (use the Beneficiary Election Form.) • you want to request an annuity (if your Plan allows, use the Annuity Request Form.) To participate in the program, the following conditions must be met: You must have terminated your employment with your employer and no longer make contributions to the plan. You may not have an outstanding loan or SDBA program. If you have an outstanding loan it will be defaulted. Systematic Withdrawal/ Installment Payment Option Request for participants who have separated from service (i.e., retired, terminated or become disabled) 457(b) Governmental, 401 Governmental, and 403(b) If the plan's normal form of benefit is a Qualified Joint and Survivor Annuity (QJSA), the Qualified Joint and Survivor Annuity Form must be completed by the participant (and spouse, if applicable) and provided to the Plan Administrator prior to a distribution being processed. If the Plan's normal form of benefit is not a QJSA, but requires spousal consent for a distribution a Spousal Consent Form must be completed and provided to the Plan Administrator prior to a distribution being processed. MassMutual Retirement Services will not process this form until it is received in good order. Please see the Important Information Section for information on "Good Order" requirements. REQUIRED: Participant's Severance from Service/ Retirement Date: Questions? Call MassMutual’s Customer Service Center 1-800-528-9009 Fax 877-526-2531 or 800-678-8645 Online www.massmutual.com/ govnp

Transcript of Systematic Withdrawal/ Installment Payment Option Request · Systematic Withdrawal/ Installment...

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Section A - Plan Information (required)Plan NameGroup No.

Section B - Participant Information (required)

* Legal Address Daytime Phone Number

Zip CodeStateCity

Date of BirthParticipant NameSSN

*We will change your account information to reflect the Legal Address above and all future mailings will be sent to this address unless changed by you or your Plan Administrator as described under "Stale Address" in the Important Information Section.

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Use this form if you want to: • request a series of payments from your vested account. Do not use this form if: • you want to modify or terminate an existing SWO/IPO program. Use the Systematic Withdrawal/ Installment Payment Option Change Form. You may use the Change Form to stop the program or make changes to the following: payment amount; withholding; EFT; payment date; payment frequency; specific investment choices or contribution sources. • you want to request a hardship withdrawal under a 403(b) or 401(k) plan (if your Plan allows, use the Hardship Withdrawal Request Form) or Unforeseeable Emergency Withdrawal under a 457(b) plan (if your Plan allows, use the Unforeseeable Emergency Withdrawal Request Form.) • you are 70½ or older and your accumulated installment payments for the year are not sufficient to fulfill your current year Required Minimum Distribution (RMD) (use the Required Minimum Distribution Request Form to request the additional amount.) • you are a requesting a distribution following the death of a Plan Participant (use the Beneficiary Election Form.) • you want to request an annuity (if your Plan allows, use the Annuity Request Form.) To participate in the program, the following conditions must be met: • You must have terminated your employment with your employer and no longer make contributions to the plan. • You may not have an outstanding loan or SDBA program. If you have an outstanding loan it will be defaulted.

Systematic Withdrawal/ Installment Payment Option Request for participants who have separated from service (i.e., retired, terminated or become disabled)457(b) Governmental, 401 Governmental, and 403(b)

If the plan's normal form of benefit is a Qualified Joint and Survivor Annuity (QJSA), the Qualified Joint and Survivor Annuity Form must be completed by the participant (and spouse, if applicable) and provided to the Plan Administrator prior to a distribution being processed. If the Plan's normal form of benefit is not a QJSA, but requires spousal consent for a distribution a Spousal Consent Form must be completed and provided to the Plan Administrator prior to a distribution being processed. MassMutual Retirement Services will not process this form until it is received in good order. Please see the Important Information Section for information on "Good Order" requirements.

REQUIRED: Participant's Severance from Service/ Retirement Date:

Questions? Call MassMutual’s Customer Service Center 1-800-528-9009 Fax 877-526-2531 or 800-678-8645 Online www.massmutual.com/govnp

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Section C - Installment Payment Withdrawal Schedule (required)

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Installment Type: (Select one)

Fixed-dollar installments in the amount of $

A fixed number of payments until my account is depleted.

($100 minimum) until my account is depleted.

Note: Installment payments may not be over a period greater than your life expectancy.

2.

1.

% of my account value to be withdrawn each payment cycle.

Monthly Quarterly Semi-annually Annually

Installment Payment Frequency: Subsequent payments will be made in increments according to the frequency selected. (Select one)

I understand that my election will remain in place until my account is depleted or I submit a Systematic Withdrawal/ Installment Payment Option Change Form. If you are 70½ or older and your accumulated installment payments for the year are not sufficient to fulfill your current year RMD use the Required Minimum Distribution Request Form to request the additional amount. Payments will be based on my elections below:

3.

Please note: When selecting your date, this is the day your payment will be processed. Please allow 2-3 additional days before payment is sent. Effective: Month (MM) Day (DD) Year (YYYY)

Installment Process Date: Select a date for payments to begin. Select a day from 1-28. The 1st day of the month is the default if no election is made.

Roth Contribution Source Election: If your account contains Roth contributions/rollovers you may, but are not required to, elect a percentage to be taken from the Roth source(s). I hereby elect MassMutual to take (whole percentage) of my Roth contribution source(s). (Default is zero percent (0%) from your Roth

contribution source(s) if no election is made.)%

Special Instructions

Your withdrawal will be processed pro-rata across all of your contribution sources (excluding Roth sources, if any) and investments unless Special Instructions are provided below. If you select more than one specific contribution source, you may receive separate payments for each contribution source you select. If one or more of your specified contribution sources or investments are depleted, payments will be suspended until we receive new instructions from you regarding future payments.

Section D - Source of Payment

Section E - Payment Instructions (Complete if applicable)

Mailing Address

Zip CodeStateCity

We will mail a check to you at the legal address provided in Section B unless you select an alternative mailing address below. Note: Checks will be mailed within seven days after the processing date.

Deposit into my: (Select one) Checking Savings Please provide a voided check or deposit slip.

Financial Institution Account Name

Financial Institution Account Number

Financial Institution Transit Routing Number/ ABA Number (9 digits)

Name of Financial Institution

You may elect to receive your installment payments via Electronic Funds Transfer (EFT). By completing the information below and signing in Section H, I authorize MassMutual to initiate credit entries (and to initiate, if necessary debit entries and adjustments for any credit entries made in error) to my account indicated below and the Financial Institution ("Depository") named below, to credit and/or debit the same to such account. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. This authority is to remain in full force and effect until MassMutual has received written notification from me of its termination in such time and in such a manner as to afford MassMutual and Depository a reasonable opportunity to act on it. Note: payments from the Roth contribution source are not eligible for EFT. Roth payments will be sent in a check to the legal address.

Note: If the date you select falls before the date MassMutual processes this form, your 1st installment payment will be paid immediately; all future payments will be made on the date you select.

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Section F - Federal Income Tax Withholding

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Federal Income Tax Withholding is based on whether your installment payments will be paid over a period of less than 10 years or over a period of 10 years or more. If applicable, make your withholding election below.

I elect federal income tax withholding based upon the following marital status and exemptions:

Withhold the mandatory 20%, plus I voluntarily elect to have additional withholding of $ % (whole % only) OR

Number of exemptions:

Installment Payments Over a Period of 10 Years or More - These are considered periodic payments and voluntary income tax withholding applies. If you do not make a withholding election, MassMutual will withhold federal income taxes on the taxable portion of your payment as if you are married claiming three(3) withholding allowances. (Please note that you are liable for payment of federal income tax on your distribution. You may also be subject to tax penalties under the estimated tax payment rules if your payments of estimated tax and withholding, if any, are not adequate.) Additionally, withholding is based upon the IRS tax tables and your payment amount thus it is possible that no withholding will be deducted from your payment.

I elect no federal income tax withholding. Note: If you are a U.S. citizen residing abroad you may not elect out of federal withholding.

Married Single

Installment Payments Over a Period of Less Than 10 Years - These are considered eligible rollover distributions. Mandatory 20% federal income tax withholding applies on the taxable portion of your payments unless you elected to directly roll over your installment payments. You may also make an additional voluntary withholding election below.

I elect additional federal income tax withholding of $

Federal Income Tax withholding will apply at a rate determined by treating you as married claiming 3 exemptions unless you elect otherwise below.

Section G - State Income Tax Withholding Skip this Section if you reside in a state with no income tax or withholding on retirement income. The taxable portion of your payment may also be subject to state income tax withholding. If you do not make an election below, state income taxes will only be withheld if required by state law. (Note: If state income taxes are not withheld you are liable for payment of state income tax on your distribution. In certain states you may also be subject to tax penalties under estimated tax payment rules if your payments of estimated tax and withholding, if any, are not adequate.) Your options for state tax withholding are: (Note: These rules are subject to change at any time. For current tax information pertaining to your resident state, please contact your tax advisor or your state income tax department.)

AR, DC, DE, IA, KS, ME, MD, MA, NC, NE, OK, VT, VA

These states require mandatory state withholding if federal taxes are withheld. MassMutual is required to withhold based on state law. You may not elect out of state income tax withholding.

CA, OR

These states permit voluntary income tax withholding. You may voluntarily elect state withholding by providing an election below:AL, AZ, CO, CT, GA, ID, IL, IN, KY,

LA, MN, MS, MO, MT, NJ, NM, NY, ND, OH, PA, RI, SC, UT, WV, WI I voluntarily elect to withhold an amount of: $

This state requires mandatory state withholding. MassMutual is required to withhold state income taxes based on state law unless you provide alternate withholding instructions by completing a Michigan Withholding Certificate (MI W-4P Withholding Certificate for Michigan Pension and Annuity Payments) and submitting it with this form.

MI

These states require mandatory state withholding. MassMutual is required to withhold state income taxes based on state law unless you elect out of withholding: I elect no state income tax withholding.

% (whole % only) OR

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Section H - Participant Certification and Authorization (required)I hereby instruct the Plan to distribute my vested account balance in the manner indicated on this form. I certify that all the information I provided in this form is true and accurate to the best of my knowledge and belief. I understand that providing false or misleading information on this form may constitute fraud and be subject to severe penalties. I acknowledge that: • I have received and read the Summary Plan Description, was able to ask and receive answers to my questions from the Plan Administrator and agree to be bound by the Plan’s provisions. • I have received and read the Distribution Notice and Special Tax Notice and the Important Information Section of this form. • If my plan requires spousal consent for a distribution, I have provided my employer with a properly executed spousal consent for distribution form and, if applicable, that I have received and read the Qualified Joint and Survivor Annuity Form. • I have reviewed the state income tax withholding rules in Section G and the attached Fraud Warning Statements, as applicable to my state. I understand that the state income tax withholding rules described in Section G may have changed. Any periodic federal and/or state withholding elections made in Sections F and G will continue until I change it. • If I am required to receive a RMD it is my responsibility to ensure that my accumulated installment payments satisfy the IRS RMD rules and I am aware that if the RMD is not paid for the appropriate amount and by the applicable IRS deadline I may be subject to an additional IRS 50% excise tax. • I consent to an immediate distribution as selected on this form and affirmatively waive the minimum 30-day notice waiting period. Note: If the check associated with this request is returned to MassMutual by the U.S. Postal Service as undeliverable, we are unlikely to resend it until you provide us with your updated address. Failure to provide us with your current and valid address may result in the check being considered abandoned property under the laws of the State where the check was mailed (unless preempted by ERISA). Important Note for Participants with a Non-U.S. or Non-U.S. Territory residence address: Please check this box if you are not a resident of the United States or a United States Territory. If the current address is not an address within the U.S. or one of its territories, the Participant or Beneficiary receiving the distribution is required to fill out and return a Citizenship Statement form with the distribution request. Failure to provide a Citizenship Statement will result in U.S. Federal taxes being withheld at a rate of 30% for recipients with a non-U.S. residence address. Please ask your Plan Sponsor for a Citizenship Statement form or call MassMutual's Customer Service Center for a copy. ________________________________________________________ ________________________ Participant’s Signature Date

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Section I - Plan Administrator Certification and Authorization (required)

__________________________________________________________ _________________________ Authorized Plan Signatory/ Representative's Signature Date _______________________________________________________________ Authorized Plan Signatory/ Representative's Name (please print)

Completed and signed forms in “good order” may be Faxed to 877-526-2531 or 800-678-8645; or mailed to:

Please be sure the below signatory is on record as an authorized signer for your Plan at MassMutual.

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Overnight Mail Address: MassMutual Retirement Services 1 Griffin Road North Windsor, CT 06095-1512

Regular Mail Address: MassMutual Retirement Services P.O. Box 1583 Hartford, CT 06144-1583

%Vesting: Other (Specify)%

Vesting: Employer Supplemental%

Vesting: Employer Match

If applicable, indicate the vesting percentage:

For 457(b), 401, and 403(b) plans subject to ERISA: As Plan Administrator or an authorized representative of the Plan, I hereby direct MassMutual to distribute from the Plan's group annuity contract or funding agreement as a withdrawal from the participant’s vested account the amount necessary to pay the benefit in the manner indicated in this form in accordance with the terms of the Plan and participant election. I have verified the Participant Information, Vesting, and certify that it is true and accurate to the best of my knowledge and that I have obtained any spousal consent for distribution forms (and, if applicable, provided the Qualified Joint and Survivor Annuity Form to the participant) that may be required by the Plan and/or ERISA and the Internal Revenue Code. I have verified that the installment payment period indicated in Section F is correct and if the installments are over a period of 10 years or more, I provided this participant an IRS Form W-4P(or substitute form). I acknowledge that this form does not constitute a delegation by the Plan Administrator of, and the Plan Administrator has not otherwise delegated, its income tax withholding duties and liabilities under §3405 of the Internal Revenue Code of 1986, as amended, to the Recordkeeper and that the Recordkeeper is acting as independent contractor of the Plan Administrator or Service Provider in making payments in accordance with these instructions. The Plan Administrator confirms that it is responsible for ensuring that state tax is withheld in accordance with current state law, and hereby directs MassMutual to withhold state tax, as applicable, in the manner provided on this form. The Plan Administrator confirms that it has reviewed its Plan document to confirm that the requested distribution is in fact permitted and assumes all responsibility for any consequences that result from such distribution, including any correction or disqualification that results from an impermissible distribution. I have reviewed the Plan document as well as the Plan's group annuity contract or funding agreement, and I, and not MassMutual, have made the determination that the participant is eligible under the terms of the Plan and contract to receive this distribution. In the event that the distribution is at any time determined to have been impermissible under the terms of the Plan or contract and applicable qualified plan rules, I agree that MassMutual and its affiliates shall have no responsibility, financially or otherwise, for any associated correction, costs, taxes, fees, expenses, charges, fines, penalties, charges, excise taxes or any other related amount. Note: If a distribution is being sent directly to the participant and the address provided above is currently identified as “stale” on our recordkeeping system, this transaction will not be processed until you have provided an updated address. For 403(b) plans not subject to ERISA: Consistent with Field Assistance Bulletin 2007-02, under the DOL guidelines, a program could include terms requiring the employer to certify to a provider a statement of facts within the employer's knowledge as employer. I certify the following: • That the terms of the plan allow for systematic withdrawals. • That the participant has separated from service.

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Good Order - "Good Order" means that all sections of the form are complete, the participant has provided their signature authorizing the transaction (if required) and the Plan Sponsor has provided their signature authorizing MassMutual to process the transaction requested on the form. Stale Address - It is important that you notify us if you change your address. Going forward, your address may change in our records either at your or your employer's direction, or as a result of an address confirmation service provided under our agreement with your employer. Under this service, the addresses in our records are compared against and updated quarterly with addresses received from commercial address update services (e.g., the U.S. Postal Service). If your mail is returned to us or your employer tells us your address is incorrect, we are likely to suspend future mailings until a new address is obtained. Unless preempted by federal law, failure to give us a current address may also result in uncashed distributions from your participant account being considered abandoned property under state law, and remitted to the applicable state. To update your address, contact your Plan Administrator or, if permitted by your Plan, log in to our website at www.massmutual.com/govnp and select the "My Profile" tab at the top of the screen. Loans - If you have an outstanding loan balance, your loan note and/or your employer's loan program may provide that your loan balance will be due and payable upon termination of employment. Please contact the Plan Administrator to learn the rules that apply to your plan. Any outstanding loan principal and due but unpaid interest will be tax reported as taxable income, except for any portion of the loan’s principal that is secured by employee after-tax contributions. The taxable portion of the loan and cash distribution, if any, will be combined to calculate federal and, if applicable, state income tax withholding. Some plans may also allow for the direct rollover of an outstanding loan balance.

Section J - Important Information

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MassMutual Financial Group is a marketing name for Massachusetts Mutual Life Insurance Company (MassMutual) (of which Retirement Services is a division) and its affiliated companies and sales representatives.

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Maine - It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties may include imprisonment, fines or a denial of insurance benefits. Maryland - Any person who knowingly or willfully presents a false or fraudulent claim for payment of a loss or benefit or who knowingly or willfully presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. Minnesota - A person who files a claim with intent to defraud or helps commit a fraud against an insurer is guilty of a crime. New Hampshire - Any person who, with a purpose to injure, defraud or deceive any insurance Company, files a statement of claim containing any false, incomplete or misleading information is subject to prosecution and punishment for insurance fraud, as provided in RSA 638:20. However, the lack of such a statement shall not constitute a defense against prosecution under RSA 638:20. New Jersey - Any person who knowingly includes any false or misleading information on an application for an insurance policy, or files a statement of claim containing any false or misleading information, is subject to criminal and civil penalties. New York - Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation. Ohio - Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement, is guilty of insurance fraud. Oklahoma - Warning: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony. Pennsylvania - Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties. Tennessee - It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines and denial of insurance benefits. FWS Rev 9.12

NAIC Model Fraud Statement: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. Alabama - Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or who knowingly presents false information in an application for insurance is guilty of a crime and may be subject to restitution fines or confinement in prison, or any combination thereof. Arkansas - Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. Colorado - It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance, and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or misleading facts or information to a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or claimant with regard to settlement or award payable from insurance proceeds shall be reported to the Colorado Division of Insurance within the Department of Regulatory Services. District of Columbia - Warning: It is a crime to provide false or misleading information to an insurer or any other person. Penalties include imprisonment and/or fines. In addition, an insurer may deny insurance benefits if false information materially related to a claim was provided by the applicant. Florida - Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree. Indiana - A person who knowingly and with intent to defraud an insurer files a statement of claim containing any false, incomplete, or misleading information commits a felony. Kentucky - Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime. Louisiana - Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.

Fraud Warning Statements The following states require insurance applicants to acknowledge a fraud warning statement specific to that state. Please refer to the specific fraud warning statement for your state as indicated below. If your state is not separately listed, please refer to the NAIC Model Fraud Statement below.

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DISTRIBUTION NOTICE

The Plan is required to provide you with information that explains your distribution options and the federal income tax implications of a Plan distribution prior to the receipt of assets from your account. As a Plan participant you must receive these notices (the “Distribution Notice” and the “Special Tax Notice” enclosed) at least thirty (30) days prior to your distribution. If you received the notice more than one hundred eighty (180) days prior to taking a distribution, you must receive either a new notice or a notice summary. You have the ability to waive the remaining unexpired notice period if you elect a payment from the Plan prior to the expiration of the 30 day period. Please note that the value of your account will continue to increase or decrease based on market performance until it is distributed or forfeited, as appropriate, in its entirety.

Your Right to Defer Distribution and Direct Account Investments. If you have terminated employment and your balance in the Plan is over $5,000, you may choose to defer the distribution of your account until a later date. If you elect to defer the distribution of your account, you may continue to direct the investment of your account among the investment options offered by the Plan. Your account will continue to be subject to market fluctuation based upon its investment. For more information on the investment options available under the Plan, please consult your Plan enrollment kit, log on to your internet account or contact your Plan Administrator. Your Ability to Rollover Your Account. You may elect to have the balance of your account paid to you directly or to the custodian or trustee of another eligible retirement plan (including an IRA). Please note that the taxable portion of the distributed amount will be included in your taxable income at the

time of the distribution (unless you elect to directly rollover the balance) and will no longer be invested in the investment options available under the Plan. The attached Special Tax Notice explains the federal income tax consequences of eligible rollover distributions and the types of retirement plans which may receive such distributions. Your Consent Not Required for Distribution of De Minimus Amounts. The Plan may pay out certain account balances below $5,000 without your consent in accordance with the terms of the Plan, which are described in the Plan’s Summary Plan Description (“SPD”). If your account balance is below $5,000 and otherwise subject to the Plan’s cash-out provisions, the Plan may pay a distribution of your account balance to you or to an eligible retirement plan on your behalf as determined by the Plan Administrator. However, in such event the Plan will notify you of the pending distribution and you may generally elect to rollover the distribution. All notices will be sent to your address of record on file with the

Plan; if you move please inform the Plan of your new address to ensure that you continue to receive these important materials. You should consult with a tax advisor prior to requesting a distribution to determine the financial impact of each form of distribution. Your Plan’s Distribution Option(s) The distribution options offered in your Plan are described in the Plan’s SPD and/or in a Summary of Material Modifications (“SMM”). If your plan requires that you (and your spouse, if you are married) consent to any distribution that is not in the form of a qualified annuity, you must also be provided with a notice describing this annuity form of benefit and the procedures for waiving it, if you would prefer an alternate form of benefit. The SPD and SMM also contain information describing the form and timing of distribution payments. Please contact your Plan Administrator to request a copy of the SPD and/or SMM.

SPECIAL TAX NOTICE YOUR ROLLOVER OPTIONS

How can a rollover affect my taxes? Not a Designated Roth Account: You will be taxed on a payment from the Plan if you do not roll it over. If you are under age 59½ and do not do a rollover, you will also have to pay a 10% additional income tax on early distributions (unless an

You are receiving this notice because all or a portion of a payment you are receiving from the Plan is eligible to be rolled over to an IRA or an employer plan; or if your payment is from a Designated Roth Account (a type of account with special tax rules in some employer plans), to a Roth IRA or Designated Roth Account in an employer plan. This notice is intended to help you decide whether to do such a rollover. This notice describes the rollover rules that apply to payments from the Plan. To the extent that the rules differ based on whether the payment is from a Designated Roth Account or from an account that is not a Designated Roth Account, the differences will be identified in each applicable section of this notice. In addition, if you receive a payment from a Designated Roth Account and a payment from an account that is not a Designated Roth Account in the Plan, you may contact the Plan administrator or the Plan’s recordkeeper for assistance in determining the amount that is being paid from each account. Rules that apply to most payments from a plan are described in the “General Information About Rollovers” section. Special rules that only apply in certain circumstances are described in the “Special Rules and Options” section.

exception applies). However, if you do a rollover, you will not have to pay tax until you receive payments later and the 10% additional income tax will not apply if those payments are made after you are age 59½ (or if an exception applies). If you do a rollover to a Roth IRA, a special rule applies under which the amount of the payment rolled over (reduced by any after-tax amounts) will be taxed; please see the “If you rollover your payment from an account which is not a Designated Roth Account to a Roth IRA” section under “Special Rules and Options” below.

Designated Roth Account: After-tax contributions included in a payment from a Designated Roth Account are not taxed, but earnings might be taxed. The tax treatment of earnings included in the payment depends on whether the payment is a qualified distribution. If a payment is only part of your Designated Roth Account, the payment will include an allocable portion of the earnings in your Designated Roth Account.

General Information About Rollovers

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rollover by making a deposit within 60 days into a Designated Roth Account in an employer plan if the payment is a nonqualified distribution and the rollover does not exceed the amount of the earnings in the payment. You cannot do a 60-day rollover to an employer plan of any part of a qualified distribution. If you receive a distribution that is a nonqualified distribution and you do not roll over an amount at least equal to the earnings allocable to the distribution, you will be taxed on the amount of those earnings not rolled over, including the 10% additional income tax on early distributions if you are under age 59½ (unless an exception applies). If you do a direct rollover of only a portion of the amount paid from the Plan and a portion is paid to you at the same time, the portion directly rolled over consists first of earnings. If you do not do a direct rollover and the payment is not a qualified distribution, the Plan is required to withhold 20% of the earnings for federal income taxes (up to the amount of cash and property received other than employer stock). This means that, in order to roll over the entire payment in a 60-day rollover to a Roth IRA, you must use other funds to make up for the 20% withheld. How much may I roll over? If you wish to do a rollover, you may roll over all or part of the amount eligible for rollover. Any payment from the Plan is eligible for rollover, except: • Certain payments spread over a period of at least 10 years or over your life or life expectancy (or the lives or joint life expectancy of you and your beneficiary) • Required minimum distributions after age 70½ (or after death) • Hardship distributions • ESOP dividends • Corrective distributions of contributions that exceed tax law limitations • Loans treated as deemed distributions (for example, loans in default due to missed payments before your employment ends) • Cost of life insurance paid by the Plan • Payments of certain automatic enrollment contributions requested to be withdrawn within 90 days of the first contribution. • Amounts treated as distributed because of a prohibited allocation of S corporation stock under an ESOP (also, there will generally be adverse tax consequences if you roll over a distribution of S corporation stock to an IRA). The Plan administrator or the Plan’s recordkeeper can tell you what portion of a payment is eligible for rollover.

IRAs and Roth IRAs may not provide loans). Further, the amount rolled over will become subject to the tax rules that apply to the Roth IRA or the Designated Roth Account in the employer plan. In general, these tax rules are similar to those described elsewhere in this notice, but differences include: • If you do a rollover to a Roth IRA, all of your Roth IRAs will be considered for purposes of determining whether you have satisfied the 5- year rule (counting from January 1 of the year for which your first contribution was made to any of your Roth IRAs). • If you do a rollover to a Roth IRA, you will not be required to take a distribution from the Roth IRA during your lifetime and you must keep track of the aggregate amount of the after-tax contributions in all of your Roth IRAs (in order to determine your taxable income for later Roth IRA payments that are not qualified distributions). • Eligible rollover distributions from a Roth IRA can only be rolled over to another Roth IRA. How do I do a rollover? There are two ways to do a rollover. You can do either a direct rollover or a 60-day rollover. If you do a direct rollover, the Plan will make the payment directly to your IRA or an employer plan, or if your payment is from a Designated Roth Account, to your Roth IRA or Designated Roth Account in an employer plan. You should contact the IRA or Roth IRA custodian or the administrator of the employer plan for information on how to do a direct rollover. If you do not do a direct rollover, you may still do a rollover by making a deposit within 60 days in accordance with the following rules: Not a Designated Roth Account: You may make a deposit into an IRA or eligible employer plan that will accept it. You will have 60 days after you receive the payment to make the deposit. If you do not do a direct rollover, the Plan is required to withhold 20% of the payment for federal income taxes (up to the amount of cash and property received other than employer stock). This means that, in order to roll over the entire payment in a 60-day rollover, you must use other funds to make up for the 20% withheld. If you do not roll over the entire amount of the payment, the portion not rolled over will be taxed and will be subject to the 10% additional income tax on early distributions if you are under age 59½ (unless an exception applies). Designated Roth Account: You may make a deposit within 60 days into a Roth IRA, whether the payment is a qualified or nonqualified distribution. In addition, you can do a

If the payment from the Plan is not a qualified distribution and you do not do a rollover to a Roth IRA or a Designated Roth Account in an employer plan, you will be taxed on the earnings in the payment. If you are under age 59½, a 10% additional income tax on early distributions will also apply to the earnings (unless an exception applies). However, if you do a rollover, you will not have to pay taxes currently on the earnings and you will not have to pay taxes later on payments that are qualified distributions. If the payment from the Plan is a qualified distribution, you will not be taxed on any part of the payment even if you do not do a rollover. If you do a rollover, you will not be taxed on the amount you roll over and any earnings on the amount you roll over will not be taxed if paid later in a qualified distribution. A qualified distribution from a Designated Roth Account in the Plan is a payment made after you are age 59½ (or after your death or disability) and after you have had a Designated Roth Account in the Plan for at least 5 years. In applying the 5-year rule, you count from January 1 of the year your first contribution was made to the Designated Roth Account. However, if you did a direct rollover to a Designated Roth Account in the Plan from a Designated Roth Account in another employer plan, your participation will count from January 1 of the year your first contribution was made to the Designated Roth Account in the Plan or, if earlier, to the Designated Roth Account in the other employer plan. Please note that if you have after-tax or Roth money in your plan and that money was formerly held by another service provider who did not supply your current service provider with comprehensive account information at the time the funds were transferred to your current service provider, tax reporting of the distribution may be affected. Where may I roll over the payment? Not a Designated Roth Account: You may roll over the payment to either an IRA (an individual retirement account or individual retirement annuity) or an employer plan (a tax-qualified plan, section 403(b) plan, or governmental section 457(b) plan) that will accept the rollover. The rules of the IRA or employer plan that holds the rollover will determine your investment options, fees, and rights to payment from the IRA or employer plan (for example, no spousal consent rules apply to IRAs and IRAs may not provide loans). Further, the amount rolled over will become subject to the tax rules that apply to the IRA or employer plan. Designated Roth Account: You may roll over the payment to either a Roth IRA (a Roth individual retirement account or Roth individual retirement annuity) or a Designated Roth Account in an employer plan (a tax-qualified plan or section 403(b) plan) that will accept the rollover. The rules of the Roth IRA or employer plan that holds the rollover will determine your investment options, fees, and rights to payment from the Roth IRA or employer plan (for example, no spousal consent rules apply to Roth

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If I don’t do a rollover, will I have to pay the 10% additional income tax on early distributions? Not a Designated Roth Account: If you are under age 59½, you will have to pay the 10% additional income tax on early distributions for any payment from the Plan (including amounts withheld for income tax) that you do not roll over, unless one of the exceptions listed below applies. This tax is in addition to the regular income tax on the payment not rolled over. Designated Roth Account: If a payment is not a qualified distribution and you are under age 59½, you will have to pay the 10% additional income tax on early distributions with respect to the earnings allocated to the payment that you do not roll over (including amounts withheld for income tax), unless one of the exceptions listed below applies. This tax is in addition to the regular income tax on the earnings not rolled over. Exceptions: The 10% additional income tax does not apply to the following payments from the Plan: • Payments made after you separate from service if you will be at least age 55 in the year of the separation • Payments that start after you separate from service if paid at least annually in equal or close to equal amounts over your life or life expectancy (or the lives or joint life expectancy of you and your beneficiary) • Payments from a governmental defined benefit pension plan made after you separate from service if you are a public safety employee and you are at least age 50 in the year of the separation • Payments made due to disability • Payments after your death • Payments of ESOP dividends • Corrective distributions of contributions that exceed tax law limitations • Cost of life insurance paid by the Plan • Payments made directly to the government to satisfy a federal tax levy • Payments made under a qualified domestic relations order (QDRO) • Payments up to the amount of your deductible medical expenses • Certain payments made while you are on active duty if you were a member of a reserve component called to duty after September 11, 2001 for more than 179 days

• Payments of certain automatic enrollment contributions requested to be withdrawn within 90 days of the first contribution. If I do a rollover to an IRA, will the 10% additional income tax apply to early distributions from the IRA? If you receive a payment from an IRA when you are under age 59½, you will have to pay the 10% additional income tax on early distributions from the IRA, unless an exception applies. In general, the exceptions to the 10% additional income tax for early distributions from an IRA are the same as the exceptions listed above for early distributions from a plan. However, there are a few differences for payments from an IRA, including: • There is no exception for payments after separation from service that are made after age 55. • The exception for qualified domestic relations orders (QDROs) does not apply (although a special rule applies under which, as part of a divorce or separation agreement, a tax-free transfer may be made directly to an IRA of a spouse or former spouse). • The exception for payments made at least annually in equal or close to equal amounts over a specified period applies without regard to whether you have had a separation from service. • There are additional exceptions for: (1) payments for qualified higher education expenses, (2) payments up to $10,000 used in a qualified first- time home purchase, and (3) payments for health insurance premiums after you have received unemployment compensation for 12 consecutive weeks (or would have been eligible to receive unemployment compensation but for self- employed status). If I do a rollover to a Roth IRA, will the 10%additional income tax apply to early distributions from the IRA? If you receive a payment from a Roth IRA when you are under age 59½, you will have to pay the 10% additional income tax on early distributions on the earnings paid from the Roth IRA, unless an exception applies or the payment is a qualified distribution. In general, the exceptions to the 10% additional income tax for early distributions from a Roth IRA listed above are the same as the exceptions for early distributions from a plan. However, there are a few differences for payments from a Roth IRA, including: • There is no special exception for payments after separation from service. • The exception for qualified domestic relations orders (QDROs) does not apply (although a special rule applies under which, as part of a divorce or separation agreement, a tax-free

transfer may be made directly to a Roth IRA of a spouse or former spouse). • The exception for payments made at least annually in equal or close to equal amounts over a specified period applies without regard to whether you have had a separation from service. • There are additional exceptions for (1) payments for qualified higher education expenses, (2) payments up to $10,000 used in a qualified first- time home purchase, and (3) payments for health insurance premiums after you have received unemployment compensation for 12 consecutive weeks (or would have been eligible to receive unemployment compensation but for self- employed status). Will I owe State income taxes? This notice does not describe any State or local income tax rules (including withholding rules). SPECIAL RULES AND OPTIONS If your payment includes after-tax contributions and is not from a Designated Roth Account After-tax contributions included in a payment are not taxed. If a payment is only part of your benefit, an allocable portion of your after-tax contributions is included in the payment, so you cannot take a payment of only after-tax contributions. However, if you have pre-1987 after-tax contributions maintained in a separate account, a special rule may apply to determine whether the after-tax contributions are included in a payment. In addition, special rules apply when you do a rollover, as described below. You may roll over to an IRA a payment that includes after-tax contributions through either a direct rollover or a 60-day rollover. You must keep track of the aggregate amount of the after-tax contributions in all of your IRAs (in order to determine your taxable income for later payments from the IRAs). If you do a direct rollover of only a portion of the amount paid from the Plan and at the same time the rest is paid to you, the portion directly rolled over consists first of the amount that would be taxable if not rolled over. For example, assume you are receiving a distribution of $12,000, of which $2,000 is after-tax contributions. In this case, if you directly rolled over $10,000 to an IRA that is not a Roth IRA, no amount is taxable because the $2,000 amount not directly rolled over is treated as being after-tax contributions. If you do a direct rollover of the entire amount paid from the Plan to two or more destinations at the same time, you can choose which destination receives the after-tax contributions. If you do a 60-day rollover to an IRA of only a portion of the payment made to you, the after-tax contributions are treated as rolled over last. For example, assume you are receiving a distribution of $12,000, of which $2,000 is after-tax contributions, and no part of the distribution is directly rolled over. In this case, if you roll over $10,000 to an IRA that is

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not a Roth IRA in a 60-day rollover, no amount is taxable because the $2,000 amount not rolled over is treated as being after-tax contributions. You may roll over to an employer plan all of a payment that includes after-tax contributions, but only through a direct rollover (and only if the receiving plan separately accounts for after-tax contributions and is not a governmental section 457(b) plan. You can do a 60-day rollover to an employer plan as part of a payment that includes after-tax contributions, but only up to the amount of the payment that would be taxable if not rolled over. If you miss the 60-day rollover deadline Generally, the 60-day rollover deadline cannot be extended. However, the IRS has the limited authority to waive the deadline under certain extraordinary circumstances, such as when external events prevented you from completing the rollover by the 60-day rollover deadline. To apply for a waiver, you must file a private letter ruling request with the IRS. Private letter ruling requests require the payment of a nonrefundable user fee. For more information, see IRS Publication 590-A, Contributions to Individual Retirement Arrangements (IRAs). If your payment includes employer stock that you do not roll over Not a Designated Roth Account: If you do not do a rollover, you can apply a special rule to payments of employer stock (or other employer securities) that are either attributable to after-tax contributions or paid in a lump sum after separation from service (or after age 59½, disability, or the participant’s death). Under the special rule, the net unrealized appreciation on the stock will not be taxed when distributed from the Plan and will be taxed at capital gain rates when you sell the stock. Net unrealized appreciation is generally the increase in the value of employer stock after it was acquired by the Plan. If you do a rollover for a payment that includes employer stock (for example, by selling the stock and rolling over the proceeds within 60 days of the payment), the special rule relating to the distributed employer stock will not apply to any subsequent payments from the IRA or employer plan. The Plan administrator can tell you the amount of any net unrealized appreciation. Designated Roth Account: If you receive a payment that is not a qualified distribution and you do not roll it over, you can apply a special rule to payments of employer stock (or other employer securities) that are paid in a lump sum after separation from service (or after age 59½, disability, or the participant’s death). Under the special rule, the net unrealized appreciation on the stock included in the earnings in the payment will not be taxed when distributed to you from the Plan and will be taxed at capital gain rates when you sell the stock.

If you do a rollover to a Roth IRA for a nonqualified distribution that includes employer stock (for example, by selling the stock and rolling over the.proceeds within 60 days of the distribution), you will not have any taxable income and the special rule relating to the distributed employer stock will not apply to any subsequent payments from the Roth IRA or employer plan. Net unrealized appreciation is generally the increase in the value of the employer stock after it was acquired by the Plan. The Plan administrator can tell you the amount of any net unrealized appreciation. If you receive a payment that is a qualified distribution that includes employer stock and you do not roll it over, your basis in the stock (used to determine gain or loss when you later sell the stock) will equal the fair market value of the stock at the time of the payment from the Plan. If you have an outstanding loan that is being offset If you have an outstanding loan from the Plan, your Plan benefit may be offset by the amount of the loan, typically when your employment ends. The loan offset amount is treated as a distribution to you at the time of the offset. Not a Designated Roth Account: The outstanding loan amount will be taxed (including the 10% additional income tax on early distributions, unless an exception applies) unless you do a 60-day rollover in the amount of the loan offset to an IRA or employer plan. Designated Roth Account: If the distribution is a nonqualified distribution, the earnings in the loan offset will be taxed (including the 10% additional income tax on early distributions, unless an exception applies) unless you do a 60-day rollover in the amount of the earnings in the loan offset to a Roth IRA or Designated Roth Account in an employer plan. If you were born on or before January 1, 1936 Not a Designated Roth Account: If you were born on or before January 1, 1936 and receive a lump sum distribution that you do not roll over, special rules for calculating the amount of the tax on the payment might apply to you. For more information, see IRS Publication 575, Pension and Annuity Income. Designated Roth Account: If you were born on or before January 1, 1936 and receive a lump sum distribution that is not a qualified distribution and that you do not roll over, special rules for calculating the amount of the tax on the payment might apply to you. For more information, see IRS Publication 575, Pension and Annuity Income.

If your payment is from a governmental section 457(b) plan If the Plan is a governmental section 457(b) plan, the same rules described elsewhere in this notice generally apply, allowing you to roll over the payment to an IRA or an employer plan that accepts rollovers. One difference is that, if you do not do a rollover, you will not have to pay the 10% additional income tax on early distributions from the Plan even if you are under age 59½ (unless the payment is from a separate account holding rollover contributions that were made to the Plan from a tax-qualified plan, a section 403(b) plan, or an IRA). However, if you do a rollover to an IRA or to an employer plan that is not a governmental section 457(b) plan, a later distribution made before age 59½ will be subject to the 10% additional income tax on early distributions (unless an exception applies). Other differences are that you cannot do a rollover if the payment is due to an “unforeseeable emergency” and the special rules under “If your payment includes employer stock that you do not roll over” and “If you were born on or before January 1, 1936” do not apply. If you are an eligible retired public safety officer and your pension payment is used to pay for health coverage or qualified long-term care insurance If the Plan is a governmental plan, you retired as a public safety officer, and your retirement was by reason of disability or was after normal retirement age, you can exclude from your taxable income plan payments or nonqualified distribution paid directly as premiums to an accident or health plan (or a qualified long-term care insurance contract) that your employer maintains for you, your spouse, or your dependents, up to a maximum of $3,000 annually. For this purpose, a public safety officer is a law enforcement officer, firefighter, chaplain, or member of a rescue squad or ambulance crew. If you roll over your payment to a Roth IRA If you roll over a payment from the Plan to a Roth IRA, a special rule applies under which the amount of the payment rolled over (reduced by any after-tax amounts) will be taxed. However, the 10% additional income tax on early distributions will not apply (unless you take the amount rolled over out of the Roth IRA within 5 years, counting from January 1 of the year of the rollover). If you roll over the payment to a Roth IRA, later payments from the Roth IRA that are qualified distributions will not be taxed (including earnings after the rollover). A qualified distribution from a Roth IRA is a payment made after you are age 59½ (or after your death or disability, or as a qualified first-time homebuyer distribution of up to $10,000) and after you have had a Roth IRA for at least 5 years. In applying this 5-year rule, you count from January 1 of the year for which your first contribution was made to a Roth IRA. Payments from the Roth IRA that are not

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qualified distributions will be taxed to the extent of earnings after the rollover, including the 10% additional income tax on early distributions (unless an exception applies). You do not have to take required minimum distributions from a Roth IRA during your lifetime. For more information, see IRA Publication 590-A, Contributions to Individual Retirement Arrangements (IRAs), and IRS Publication 590-B, Distributions from Individual Retirement Arrangements (IRAs). If you do a rollover to a designated Roth account in the Plan You cannot roll over a distribution to a designated Roth account in another employer's plan. However, you can roll the distribution over into a designated Roth account in the distributing Plan. If you roll over a payment from the Plan to a designated Roth account in the Plan, the amount of the payment rolled over (reduced by any after-tax amounts directly rolled over) will be taxed. However, the 10% additional tax on early distributions will not apply (unless you take the amount rolled over out of the designated Roth account within the 5-year period that begins on January 1 of the year of the rollover). If you roll over the payment to a designated Roth account in the Plan, later payments from the Designated Roth Account that are qualified distributions will not be taxed (including earnings after the rollover). A qualified distribution from a Designated Roth Account is a payment made both after you are age 59½ (or after your death or disability) and after you have had a Designated Roth Account in the Plan for at least 5 years. In applying this 5-year rule, you count from January 1 of the year your first contribution was made to the Designated Roth Account. However, if you made a direct rollover to a Designated Roth Account in the Plan from a Designated Roth Account in a plan of another employer, the 5-year period begins on January 1 of the year you made the first contribution to the Designated Roth Account in the Plan or, if earlier, to the Designated Roth Account in the plan of the other employer. Payments from the Designated Roth Account that are not qualified distributions will be taxed to the extent of earnings after the rollover, including the 10% additional income tax on early distributions (unless an exception applies).

If you are a surviving spouse. Not a Designated Roth Account: If you receive a payment from the Plan as the surviving spouse of a deceased participant, you have the same rollover options that the participant would have had, as described elsewhere in this notice. In addition, if you choose to do a rollover to an IRA, you may treat the IRA as your own or as an inherited IRA. An IRA you treat as your own is treated like any other IRA of yours, so that payments made to you before you are age 59½ will be subject to the 10% additional income tax on early distributions (unless an exception applies) and the required minimum distributions from your IRA do not have to start until after you are age 70½. If you treat the IRA as an inherited IRA, payments from the IRA will not be subject to the 10% additional income tax on early distributions. However, if the participant had started taking required minimum distributions, you will have to receive required minimum distributions from the inherited IRA. If the participant had not started taking required minimum distributions from the Plan, you will not have to start receiving required minimum distributions from the inherited IRA until the year the participant would have been age 70½. Designated Roth Account: If you receive a payment from the Plan as the surviving spouse of a deceased participant, you have the same rollover options that the participant would have had, as described elsewhere in this notice. In addition, if you choose to do a rollover to an Roth IRA, you may treat the Roth IRA as your own or as an inherited Roth IRA.

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distributions from the Plan, you will have to receive required minimum distributions from the inherited Roth IRA. If the participant had not started taking required minimum distributions, you will not have to start receiving required minimum distributions from the inherited Roth IRA until the year the participant would have been age 70½.

If you are a surviving beneficiary other than a spouse. Not a Designated Roth Account: If you receive a payment from the Plan because of the participant's death and you are a designated beneficiary other than a surviving spouse, the only rollover option you have is to do a direct rollover to an inherited IRA. Payments from the inherited IRA will not be subject to the 10% additional income tax on early distributions. You will have to receive required minimum distributions from the inherited IRA. Designated Roth Account: If you receive a payment from the Plan because of the participant's death and you are a designated beneficiary other than a surviving spouse, the only rollover option you have is to do a direct rollover to an inherited Roth IRA. Payments from the inherited Roth IRA, even if made in a nonqualified distribution, will not be subject to the 10% additional income tax on early distributions. You will have to receive required minimum distributions from the inherited Roth IRA.

If you are not a plan participant Payments after death of the participant. If you receive a distribution after the participant’s death that you do not roll over, the distribution will generally be taxed in the same manner described elsewhere in this notice. However, the 10% additional income tax on early distributions and the special rules for public safety officers do not apply, and the special rule described under the section “If you were born on or before January 1, 1936” applies only if the participant was born on or before January 1, 1936. However, whether a payment from a Designated Roth Account is a qualified distribution generally depends on when the participant first made a contribution to the Designated Roth Account in the Plan.

A Roth IRA you treat as your own is treated like any other Roth IRA of yours, so that you will not have to receive any required minimum distributions during your lifetime and earnings paid to you in a nonqualified distribution before you are age 59½ will be subject to the 10% additional income tax on early distributions (unless an exception applies) If you treat the Roth IRA as an inherited Roth IRA, payments from the Roth IRA will not be subject to the 10% additional income tax on early distributions. An inherited Roth IRA is subject to required minimum distributions. If the participant had started taking required minimum

Payments under a qualified domestic relations order. If you are the spouse or former spouse of the participant who receives a payment from the Plan under a qualified domestic relations order (QDRO), you generally have the same options the participant would have (for example, you may roll over the payment to your own IRA or an eligible employer plan that will accept it). Payments under the QDRO that are not from a Designated Roth Account will not be subject to the 10% additional income tax on early distributions. If you are a nonresident alien If you are a nonresident alien and you do not do a direct rollover to a U.S. IRA or U.S. employer plan, instead of withholding 20%, the Plan is generally required to withhold 30% of the payment for federal income taxes. If the amount withheld exceeds the amount of tax you owe (as may happen if you do a 60-day rollover), you may request an income tax refund by filing Form 1040NR and attaching your Form 1042-S. See Form W-8BEN for claiming that you are entitled to a reduced rate of withholding under an income tax treaty. For more information, see also IRS Publication 519, U.S. Tax Guide for Aliens, and IRS Publication 515, Withholding of Tax on Nonresident Aliens and Foreign Entities.

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Mandatory Cashout Distributions Not a Designated Roth Account: Unless you elect otherwise, a mandatory cashout of more than $1,000 (not including payments from a Designated Roth Account in the Plan) will be directly rolled over to an IRA chosen by the Plan Administrator or the payor. A mandatory cashout is a payment from a plan to a participant made before age 62 (or normal retirement age, if later) and without consent, where the participant's benefit does not exceed $5,000 (not including any amounts held under the plan as a result of a prior rollover made to the plan). Designated Roth Account: Unless you elect otherwise, a mandatory cashout from the Designated Roth Account in the plan of more than $1,000 will be directly rolled over to a Roth IRA chosen by the Plan administrator or the payor. A mandatory cashout is a payment from a plan to a participant made before age 62 (or normal retirement age, if later) and without consent, where the participant's benefit does not exceed $5,000 (not including any amounts held under the plan as a result of a prior rollover made to the plan).

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FOR MORE INFORMATION You may wish to consult with the Plan administrator or a professional tax advisor before taking a payment from the Plan. Also, you can find more detailed information on the federal tax treatment of payments from employer plans in: IRS Publication 575, Pension and Annuity Income; IRS Publication 590-A Contributions to Individual Retirement Arrangements (IRAs); IRS publication 590-B, Distributions from Individual Retirement Arrangements (IRAs); and IRS Publication 571, Tax-Sheltered Annuity Plans (403(b) Plans). These publications are available from a local IRS office, on the web at www.irs.gov, or by calling 1-800-TAXFORM

Other special rules • If a payment is one in a series of payments for less than 10 years, your choice whether to make a direct rollover will apply to all later payments in the series (unless you make a different choice for later payments). • If your payments for the year are less than $200 (payments from a Designated Roth Account and from accounts that are not Designated Roth Accounts are not aggregated for purposes of the limit), the Plan is not required to allow you to do a direct rollover and is not required to withhold for federal income taxes. However, you may do a 60- day rollover. • You may have special rollover rights if you recently served in the U.S. Armed Forces. For more information, see IRS Publication 3, Armed Forces’ Tax Guide.